The purpose of this case report is to increase awareness that a diagnosis of
malignant hyperthermia may have long-lasting or permanent effects on a patient's insurance eligibility or premiums despite legislation providing varying levels of protection from preexisting conditions or genetic discrimination. We present a case of severe rigors, unexplained severe
metabolic acidosis, and severe
hyperthermia in a patient after
general anesthesia for extensive head and neck surgery. The patient was treated for
malignant hyperthermia and demonstrated a significant clinical improvement with the administration of
dantrolene. Even with an "almost certain" diagnosis of
malignant hyperthermia by clinical presentation, genetic testing was negative and the gold-standard
caffeine-
halothane contracture test has yet to be performed. Laboratory results, clinical grading scales, and genetic testing support a diagnosis of
malignant hyperthermia but the gold standard is a live muscle biopsy and
caffeine-
halothane contracture test. A clinical diagnosis of MH or a positive
caffeine-
halothane contracture test could result in exclusion from genetic discrimination legislature due to the fact that diagnosis can be confirmed without genetic testing. The fate of the Affordable Care Act may also affect how insurance companies scrutinize this disease. Improving accuracy of MH diagnosis in hospital discharge records will be crucial.